Propofol infusion syndrome: Case report and literature review Journal Article


Authors: Orsini, J.; Nadkarni, A.; Chen, J.; Cohen, N.
Article Title: Propofol infusion syndrome: Case report and literature review
Abstract: Purpose. A case of propofol infusion syndrome in a patient with respiratory failure and sepsis is reported. Summary. A 36-year-old Hispanic woman was admitted to the medical intensive care unit for treatment of respiratory failure and sepsis, likely secondary to pneumonia. Her medical history included human immunodeficiency virus infection and chronic hepatitis C virus infection. She was intubated and placed on mechanical ventilation. Empirical i.v. antimicrobial therapy was initiated with vancomycin, moxifloxacin, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and micafungin, along with corticosteroids and vasopressors. Propofol 1.5 mg/kg per hour i.v. and midazolam i.v. were initiated for secation, but the dosages of both propofol and midazolam needed to be increased due to persistent agitation. On hospital day 7, the patient developed a morbilliform rash on her neck, shoulders, and chest and multiple abnormal laboratory test values, including elevated levels of alanine transaminase, aspartate transaminase, amylase, lipase, creatine kinase, and triglycerides. Serial electrocardiograms revealed sinus tachycardia. Computed tomography of the abdomen showed hepatomegaly with fatty infiltration of the liver, no gallstones, and a normal pancreas. I.V. phenobarbital was added for sedation, and propofol was tapered and discontinued on the same day. The patient responded adequately to phenobarbital maintenance therapy and was eventually weaned off all other sedatives. The patient's laboratory test values returned to normal within 72 hours after discontinuation of the propofol infusion, and the rash and tachycardia resolved. Conclusion. Propofol infusion syndrome developed in a patient with respiratory failure and sepsis after a prolonged infusion of high-dose propofol. Copyright © 2009, American Society of Health-System Pharmacists, Inc. All rights reserved.
Keywords: adult; case report; drug withdrawal; side effect; drug megadose; drug administration schedule; midazolam; propofol; sedation; maintenance therapy; risk factors; alanine aminotransferase blood level; aspartate aminotransferase blood level; loading drug dose; pneumonia; alanine aminotransferase; aspartate aminotransferase; intensive care unit; phenobarbital; syndrome; laboratory test; hepatomegaly; sepsis; triacylglycerol; triacylglycerol blood level; creatine kinase; hydrocortisone; vancomycin; corticosteroid; toxicity; drug dose increase; amylase blood level; triacylglycerol lipase blood level; cotrimoxazole; electrocardiogram; micafungin; amylase; anesthetics; antiinfective agents; anxiolytics, sedatives and hypnotics; dosage; injections; respiratory insufficiency; steroids, cortico-; vasoconstricting agents; ceftriaxone; fentanyl; hypertensive factor; moxifloxacin; noradrenalin; piperacillin plus tazobactam; triacylglycerol lipase; vasopressin; agitation; antimicrobial therapy; artificial ventilation; creatine kinase blood level; fatty liver; hispanic; intubation; measles like rash; propofol infusion syndrome; respiratory failure; sinus tachycardia; weaning; anesthetics, intravenous; exanthema; hypnotics and sedatives; tachycardia, sinus
Journal Title: American Journal of Health-System Pharmacy
Volume: 66
Issue: 10
ISSN: 1079-2082
Publisher: American Society of Health System Pharmacists, Inc  
Date Published: 2009-05-15
Start Page: 908
End Page: 915
Language: English
DOI: 10.2146/ajhp070605
PUBMED: 19420309
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 30 November 2010" - "CODEN: AHSPE" - "Source: Scopus"
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